| NPI | 1861557696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC1794) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: FL OPC1794) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2019-07-05 |